November 2011

North Carolina workers’ compensation fraud is a profound and seemingly indelible problem that saps much needed resources, degrades trust in the system, and leads to hardship and chaos for dependants. Why, then, do so many people continue to perpetrate this crime?

For example, let’s look just over the border to West Virginia, where last week, owners of an Apple Dumplin in Oak Glen, West VA, Keith McBride and Lois Ventura, got hit with three charges of workers’ comp fraud. Investigators with the workers’ compensation fraud prosecution unit tracked the couple since July. Here’s the scoop. The 51-year-old Ventura was hurt last August at her former job at Big Cheese Pizza. She collected workers’ comp benefits as a result of that claim. All good. But then, in violation of the benefits arrangement, she started running an Apple Dumplin with her boyfriend, Mr. McBride, and continued to “receive cash and medical benefits through the workers’ compensation program.”

When questioned about his girlfriend’s allegedly fraudulent activities, McBride “reportedly misrepresented the facts of the case by stating that he was the sole owner of the business and had no knowledge of the workers’ compensation benefits Ventura was receiving.” Not a good move. Now both Ventura and her boyfriend face counts. On November 3, at their arraignment, they both pled not guilty. A court date has been set for January 10.

Obviously, based simply on news reports, you should avoid leaping to judgment. Unless you probe the back story, evidence, and other relevant details, it’s probably wise to withhold “convicting people in your mind,” if only to hone your ability to see life objectively.

For the sake of a discussion, let’s assume the charges are correct. What lessons can we extract?

First of all, the story suggests that a significant number of North Carolina workers’ compensation fraud cases probably result from unplanned errors and inappropriate innovations. In other words, while some people plan workers’ comp fraud far in advance, many people simply “stumble into it” because fraud is easier and faster than operating ethically.

Often, people who are simply trying to “scrape by” come to believe that somehow they have been wronged by the system and that they “deserve” to break the rules.

The story also suggests that many workers’ comp beneficiaries do not receive enough training to understand the limits of what they can and cannot do. People might know that violating workers’ comp rules is somehow “wrong” in the abstract, but they may not know the specific punishments that are likely to meet them if they commit a crime.

Often, North Carolina workers’ compensation cases discussed on the blogosphere and elsewhere revolve around relatively “dry” issues, such as the minute, discrete meanings of definitions or jurisdictions. A hot-button case out of Las Vegas, however, will almost definitely have you sitting up in your chair:

Here is the scoop, according to the Las Vegas Sun.

Last week, the Nevada Supreme Court ruled in the case of Gary Mogg, an employee for Fitzgeralds Casino Hotel assigned to monitor over three dozen television screens, acting in the capacity of “eye in the sky.” One day, in January 2008, Mogg made the seemingly innocuous decision to put his feet up on his desk. Lo and behold, he lost his balance and tipped over and severely hurt himself. Mogg claimed that the chair was defective and that he should be entitled to workers’ comp. The Casino, however, suggested that there was “implied prohibition” that prevented him from doing things like putting his feet up on his desk.

The courts have gone back and forth over whether this implied prohibition existed or not. Last week, the Nevada Supreme Court actually weighed in on the matter, ruling that “there was insufficient evidence for Gary Mogg…to qualify for industrial insurance payments.”

Reaction from the blogosphere was a bit sarcastic. One commenter, writing under the handle of BChap, wrote: “I am not of the opinion that this man should be compensated for this accident. However, if the resort is going to allow this individual to return to work, the employer should be sensitive to his medical needs and workplace safety. Maybe one of those apparatus’ that women utilize at the doctor’s office where the patient puts her feet up in the stirrups [should be installed for him.]”

If you or someone you care about has recently been hurt or made ill at work, you likely worry about having to endure this kind of sarcasm at your expense. To protect yourself and to ensure that you are treated justly not only by your employer and insurance companies but also by the system as a whole, connect immediately with a qualified North Carolina workers’ compensation law firm.

Whether you’re a prospective North Carolina workers’ compensation beneficiary, or the relative or friend of someone who was recently hurt or injured at work (e.g. hurt while doing construction outside of Raleigh or sickened by repetitive stress syndrome contracted while working at a bank in the Research Triangle), you want help with getting fair compensation, holding wrongdoers accountable, and making sure insurers play fair.

Tackling all of these issues is of paramount importance. However, you may also want to analyze the broader context and think about why workplace accidents and injuries happen every year in North Carolina and beyond.

Are workers simply careless and negligent? Are employers careless or negligent? Is the system structured in a way that creates opportunities for injury/illness?

Perhaps. Perhaps. And perhaps.

However, there may be a “hidden cause” lurking underneath many workers’ comp cases. It’s a cause that doesn’t place blame employees or employers or even the system. The problem is a fundamentally human one. It’s the problem of creeping complacency.

Let’s analyze this.

When a new employee finds a job, he or she tends to enter the arena cautiously. New employees are more likely to listen to a supervisor’s instructions, handle complex machinery with care, and avoid overly ambitious or dangerous working conditions, such as working while fatigued, working without supervision, ignoring the company’s safety policies, etc. Likewise, employers tent to “dote on” new employees, putting them through rigorous reviews, following them through intra-company educational processes, and firing workers who violate company norms.

Dial forward several years (or, in some cases, several months), and that caution vanishes, or at least diminishes. Lassitude develops. Workers are allowed – or even encouraged – to push their limits, to “bend or break the rules” to get more done in less time and for less money. For instance, a construction worker, who in his first three months of working on a job would never use a sophisticated and dangerous piece of equipment without help, might, by month eight on the job, use that piece of equipment by himself, late at night, and without paying attention.

Which worker is going to be safer: The attentive rookie or the over-confident veteran?

Of course, “the complacency problem” is not the only fundamental cause of workplace injuries or illnesses, but it is one that is not discussed enough.

In Part 1 of our series on how complacency at work impacts the North Carolina workers’ compensation system, we discussed how both workers and employers alike often act far more cautiously during the first few weeks and months of tenure.

After a certain amount of time, both the worker and the boss become comfortable with the processes and procedures, and a certain amount of slack sets in. This “slack” can be benign, neutral, or harmful. It can be benign when workers do their jobs in a more natural, fluid, resourceful way. It can be neutral when it has no impact. And it can be malignant when it creates the conditions for laziness, inaccuracy, and recklessness.

The “knee-jerk” response to this question might be: “The answer depends on the circumstances and specifics of the line of work.” And there is some truth to this response. An industrial worker who works with potentially dangerous equipment, like lathes or bulldozers, might require incremental training “refreshers” to stay sharp and focused and avoid malignant complacency. An office worker, on the other hand, at risk for developing carpal tunnel syndrome due to bad postural and typing habits, might require a very different kind of intervention. For instance, he or she might benefit from periodic massage or physical therapy, or even from changing around the office furniture every two months or so.

Businesses in general could do more to reduce worker/employer complacency. So could the government: state or even federal regulations could require certain businesses to retrain and resystematize their processes at regular intervals, for instance, to prevent malignant over-complacency. Of course, there are dangers with inherent over regulating, as well. So the policy problem is certainly a tough nut to crack. However, we should not give up on the dream of forging global-scale solutions to the complacency problem.

Unfortunately, your quest to heal has been anything but linear. Perhaps you initially suffered some kind of insult to your musculoskeletal system – severe carpal tunnel syndrome, for instance, brought on by working a desk job somewhere in the Research Triangle – but your diagnosis got complicated, after you noticed that the numbness and tingling sensations extended beyond the afflicted area. Alternatively, perhaps you suffered spinal damage during a car crash while on a work delivery, and the extent of the nerve damage has only recently manifested, leaving both you and your doctors relatively depressed about your prognosis.

You might experience psychological setbacks, such as depression, anxiety, frustration, and loss of self-confidence. You might simultaneously feel financial setbacks, as you are compelled to pay for complicated, extensive treatment and rehab – all while making do with a reduced income stream. What’s worse, the various workers’ comp injury/illness-related stresses in your life can play off of one another, provoking a kind of a downward spiral. For instance, in your more agitated, anxious state, you may hold your body tighter and experience higher cortisol levels, which can in turn exacerbate the musculoskeletal damage you suffered at work.

Repairing physical, psychological, and financial damage is no small task, even for the well prepared. While hurt and injured workers can make significant progress by working with a reputable North Carolina workers’ compensation law firm, you still could face some pretty profound hurdles to long-term wellness.

It’s tempting to try to “deal with” all these setbacks at once, but this approach can also be discouraging. Instead, make an attempt to incorporate small, positive changes in your life, behaviors, and perspective. Just getting your e-mail under control, for instance, can restore a modicum of control and help you manage your setbacks in a more thoughtful, less reactive way.

Also, remember that even though your injury or illness might have taken just a second or even a fraction of a second to develop, doesn’t mean that you can solve the situation in a lightning-quick fashion. Instead, keep your eye on the “long road of recovery,” accept your reality for what it is, and begin to make progress, step-by-step, to move beyond the setbacks you encountered and rebuild your life, career, health, and future.

In a recent blog post, we discussed how many beneficiaries (or would-be beneficiaries) on North Carolina workers’ compensation struggle with setbacks in multiple arenas, including medical, financial, emotional, logistical, and social.

To manage these setbacks, you might find it helpful to adopt proven strategies and tactics to keep yourself better organized, more in control of your life, more relaxed, and more resilient.

This blog post cannot cover every positive behavior or beneficial scheduling strategy. However, it hopefully can encourage you to take the process of self improvement more seriously. Here are a few small but effective “good habits” to inculcate to relieve the stress of your North Carolina workers’ compensation journey.

• Get into the habit of keeping your e-mail inbox “at zero” – try out productivity guru David Allen’s GTD system for controlling e-mail (see link at the bottom of the page).

• Spend more time and energy thinking through your problems instead of acting impulsively to solve them. Do the mental work of clarifying an ideal outcome, assessing your “on the ground reality,” and brainstorming ideas to move from your present reality to your idealized future in an effective, sure-fire, cheap, and easy way. In other words, seek to break out of the habit of “acting before thinking.”

• Seek help and outside input. It’s often very difficult for victims of workplace injuries or accidents to ask for help, because victims already feel like their pride and autonomy have been compromised. Consciously break through that barrier and get help from friends, colleagues, family members, and outside resources, like a competent North Carolina workers’ compensation law firm.

• Test “catastrophic thinking.” When we get hurt or injured – when our welfare, health, social status, etc., are threatened by events or by other people – we have a tendency to imagine worst-case, catastrophic outcomes. This is a normal, human thinking, and it’s not necessarily deleterious. In fact, it can be helpful to be vigilant, depending on the situation. However, we always want to test the reality of our thoughts – especially thoughts that agitate us, keep us from sleeping, or scare us into spending hours on the Internet searching for a description and diagnosis of our symptoms.

• Thinking realistically is different from being a pollyanna. You don’t want to ignore dangerous symptoms, be they indicators of medical, financial, or psychological problems. On the other hand, we also want to detach our emotions and fears from our thoughts and seek to see them with a clear, objective lens.

• How do you cultivate this kind of clear-headed thinking? Some experts recommend engaging in daily meditative practice, such as mindful mediation, concentrated prayer, or some other exercise that enhances focus and helps you avoid getting sucked up into catastrophic thinking.

Maybe you’ve been searching for reliable information on the North Carolina workers’ compensation system for just a few minutes – or maybe you’ve spent the better part of a day or even a week analyzing tips, tricks, do’s, don’ts, and resources online. Unless you have very clear and specific goals in mind, you are likely to encounter a certain degree of stress because the internet is so overstuffed with potentially useful information.

What can you do about this problem?

The problem transcends North Carolina workers’ compensation issues and affects everyone who uses the web. Unless you engage with the web in a very specific, predetermined way, your searching may expand beyond your expectations, eat up a lot of time and energy, and, worst of all, leave you feeling more stressed and less sure than you were before the search began.

For instance, let’s say that you really hurt your wrist after engaging in some kind of chronic office work in the Raleigh area. You think you might have “carpal tunnel syndrome,” but you are not sure what the real problem is.

You also think your employer should be held responsible to pay for your time off and therapy, but you are not sure exactly how to go about making that happen, and you are certainly not clear on the applicable laws and paperwork that might pertain to your situation.

By dipping your toe in the internet to search for solutions, you will certainly get a lot of information. But you will also get way more information than you need — not all of it reliable. Do you really need to read the fine print of your employer’s workers’ comp insurance policy? Even if you could get this information, how would you interpret it and put it into context? Can you self-diagnose your pain using seemingly smart-sounding information you find online? Possibly. Or possibly not. The introduction of all these uncertainties creates tremendous stress, which you might not be aware of until someone points it out to you.

The solution?

There is no single solution. But the more you can “outsource” your tasks to reliable entities, the better. For instance, a North Carolina workers’ compensation law firm can help you take care of the paperwork and ensure that employers and insurance companies play fair.

In this post, we are going to go bit deeper. We are going to ask the question: Why does all the researching make us nuts?

The answer is partly related to the “uncertainty factor.” In other words, when you research a lot online, you may actually learn quite a bit of useful information. Theoretically, this information should make your journey toward financial recovery and physical healing faster, safer, and more certain. But in practice, we often leave our research feeling more overwhelmed than ever.

The reason is not that we’ve learned too little – or even that our information is “bad” – instead we’ve learned too much!

You can see this phenomenon at work in medical students. When a young, would-be doctor is trained, he or she often learns about all sorts of different ways the human body can go wrong. Theoretically, this powerful medical knowledge should empower people. In practice, however, often the new knowledge makes med students anxious and despairing. Why? Because the med students come to fear they have all the different diseases they study. So they have gone from a state of blissful ignorance to a state of increased knowledge and increased anxiety.

This is probably going on with web searchers looking for answers about workers’ compensation. At first, you’re blissfully unaware of the potential problems – and also what you “should” be doing about them. By the time you finish researching, you realize just how “far behind” you are. This isn’t to say that ignorance will remain bliss forever. But it reinforces the earlier lesson that the key to digging out of this rabbit hole is to connect with reputable, experienced partners, who can answer your questions and help make the system work for you.

Last Tuesday, 6-year-old boy from Duplin County was killed in a horrific North Carolina car accident on NC-111 in Chinquapin. The AP reports that the fatal North Carolina car accident occurred around 4 PM. According to the news report: “authorities’ said the boy was riding beside his older brother, who was driving a four-wheeler…the boy apparently didn’t see the oncoming vehicle and pulled out into the road.” http://www.northcarolinainjurylawyerblog.com/cgi-bin/mt.cgi?__mode=view&_type=entry&id=119145&blog_id=423

According to a local station, WITN, the 6-year-old, who attended Chinquapin Elementary School, was hit by the secretary of his school.

This horrendous tragedy strikes an emotional chord in anyone who has cared for young children. In many ways, this is every parent’s worst fear come true, and we can only hope that the family of the boy receives compassion, empathetic attention, and good healing.

Without probing into the details of what happened, it’s difficult to extrapolate. However, the report does highlight, once again, how tragedies can happen even under close adult scrutiny. Young children are constantly testing the limits of their physical environment, and they may not be fully aware of the risks inherent in their activities until too late.

While caretakers can (and probably should) do more to monitor children’s behavior and erect safe, protective areas for kids to play (without serious consequences), there are only so many strategies and tactics you can deploy to protect yourself against the chaos of life.

All that said, if you or someone your care about has been hurt in a North Carolina car accident, you may be able to avail yourself of powerful resources to get compensation for injuries, medical care, and more. A respectable and experienced North Carolina car crash law firm can help you understand your rights and what to do next.

As this North Carolina workers’ compensation blog has opined numerous times, when individuals or institutions perpetrate workers’ comp fraud – or any other kind of fraud – “downstream” effects on workers, employers, insurers, and governmental institutions can be profoundly damaging. Indeed, the North Carolina workers’ compensation system works, when it does, because various parties trust one another to act fairly and in good faith.

That’s why it’s so disturbing to read stories like a recent account from Tulsa, Oklahoma, where a local attorney pled guilty last week to embezzling more than $1 million from his clients and conspiring to commit workers’ comp fraud.

According to the Oklahoma Attorney General’s Office, 61-year old Fred Schraeder will receive a “five-year deferred sentence and will pay more than $36,000 in restitution, $500 in fines and a $100 victim’s compensation assessment… Schraeder must surrender his law license and isn’t eligible to reapply while on probation.”

Schraeder did not act alone. He apparently had an accomplice, William Anton, who was sentenced in August to pay over $700,000 in restitution and serve “four consecutive sentences totaling 35-years, with 25-years suspended.”

The Attorney General’s Office claims that Schraeder and Anton embezzled money from clients between 2004 and 2009. They stole from their “personal injury benefits, insurance settlements and workers’ compensation benefits.” Over 49 victims were identified by the Attorney General’s office.

This disturbing story highlights how important it is for sick and injured people to work with trustworthy North Carolina workers’ compensation law firms. Just because an attorney or a law firm boasts a pretty website and ostensibly credible qualifications does not mean that the team will be a “best fit” for you. Before you select your law firm, ask many questions, really research your prospective firms, and make sure you choose a firm that has a reputation for ethical behavior as well as for getting good results in complex cases similar to yours.

An October 20 AP article reports that entrepreneurs, corporations, and other free enterprise groups are considerably satisfied with the 2011 North Carolina workers’ compensation reforms.

What about the rest of us?

Before we delve into the point/counterpoint, let’s quickly review the findings of a North Carolina Free Enterprise Foundation Survey. The group found that “66% of [NC] senate members consistently support [pro-business] viewpoints, compared to 42% two years ago. In the house, it grew from 49% to 61%.”

The legislature has had a busy 2011. In addition to changing the North Carolina workers’ compensation rules, lawmakers altered medical liability litigation processes and also changed the rules by which local governments can provide high-speed internet.

That the General Assembly has become more “business friendly” should not surprise anyone; Republicans took control of the body in the 2010 elections, and Republicans, in general, tend to side with free enterprise advocates.

Notwithstanding, obviously, many lawmakers seem pretty excited with the changes and pleased with themselves for passing them. But are these changes really creating fairness in the system, saving money, and fixing the long-term structural problems which have bedeviled the workers’ comp system and other similar institutions?

Part of the problem with assessing the changes is that the North Carolina workers’ compensation reforms did not occur in a vacuum. They occurred amidst a period of tumultuous change, both in the state and on the national stage. Thus, if, in the wake of the reforms, the state witnesses business growth, favorable changes to employee health, etcetera, one cannot conclude that the changes in the law caused or even contributed to the positive effects.

Of course, likewise, if what follows during the next several years is less than ideal, for businesses, employees, and insurance companies, and one should hesitate before pinning blame on the workers’ comp reforms.

The law is, in many ways, a subset of a larger, much more complicated dynamic system. From a strictly scientific perspective, it may be nearly impossible to effectively “suss out” how small reforms to various laws ultimately redound to affect things like the regional business climate or the relative health and well being of workers.

But that’s all a little heady, especially if you are a hurt or injured worker who needs guidance through the system. A North Carolina workers’ compensation law firm can help you understand your rights and responsibilities and advocate for yourself successfully.